Farmer John A
Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Room 525 D, Houston, TX 77030, USA.
Curr Atheroscler Rep. 2007 Aug;9(2):162-8. doi: 10.1007/s11883-007-0013-8.
Diabetes is a highly prevalent disease in the United States and is increasing in both incidence and prevalence. Atherosclerotic vascular disease is a major cause of morbidity and mortality in diabetic patients. Type 2 diabetes is characterized by insulin resistance and frequently co-exists with a variety of cardiovascular risk factors, including hypertension, obesity, dyslipidemia, and physical inactivity. Hygienic measures such as weight loss and exercise should form the basis of therapeutic interventions in the prevention and treatment of type 2 diabetes. The role of dyslipidemia as a causal factor in vascular disease associated with diabetes was previously downplayed because total cholesterol was frequently normal or minimally elevated. However, diabetic dyslipidemia is characterized by elevated triglycerides, low high-density lipoprotein, and small, dense low-density lipoprotein, the combination of which has been termed the "lipid triad." The role of lipid modification as a means to decrease cardiovascular risk in type 2 diabetes has recently been clarified by a number of clinical trials. Subgroup analysis in early studies implied the potential for benefit of lipid modification in diabetes. The results of these early studies prompted the design of large-scale intervention trials in diabetes patients that employed statin and fibric acid derivatives. The preponderance of data from the statin trials implicates significant clinical benefit in cardiovascular risk reduction. The fibric acid derivatives have theoretic advantages in diabetic dyslipidemia. However, the robust bulk of clinical data obtained from prospective statin studies is lacking for the fibric acid derivatives, and the results of the major trials are equivocal.
糖尿病在美国是一种高度流行的疾病，其发病率和患病率都在上升。动脉粥样硬化性血管疾病是糖尿病患者发病和死亡的主要原因。2型糖尿病的特征是胰岛素抵抗，并且经常与多种心血管危险因素并存，包括高血压、肥胖、血脂异常和缺乏运动。诸如减肥和运动等卫生措施应成为2型糖尿病预防和治疗中治疗干预的基础。血脂异常作为与糖尿病相关的血管疾病的一个致病因素，其作用以前被低估了，因为总胆固醇通常正常或仅轻微升高。然而，糖尿病血脂异常的特征是甘油三酯升高、高密度脂蛋白降低以及小而密的低密度脂蛋白，这些因素的组合被称为“脂质三联征”。最近，一些临床试验阐明了脂质调节作为降低2型糖尿病心血管风险的一种手段的作用。早期研究中的亚组分析暗示了脂质调节对糖尿病有益的可能性。这些早期研究的结果促使设计了针对糖尿病患者的大规模干预试验，这些试验使用了他汀类药物和纤维酸衍生物。他汀类药物试验的大量数据表明在降低心血管风险方面有显著的临床益处。纤维酸衍生物在糖尿病血脂异常方面具有理论优势。然而，对于纤维酸衍生物来说，缺乏从他汀类药物前瞻性研究中获得的大量有力临床数据，并且主要试验的结果并不明确。
